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<p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 10pt; font-family: 'Arial';">Updated July 27, 2009</span></p>
<div style="text-align: center; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 0px;"><table align="center" width="886" cellspacing="0" cellpadding="4" border="0" style="border: none; border-spacing:0px; border-collapse: collapse;">
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" bgcolor="#e0e0e0" style="width:105px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Field Groups:</span></p>
</td>
<td valign="middle" width="127" bgcolor="#e0e0e0" style="width:127px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Care Ended</span></p>
</td>
<td valign="middle" width="153" bgcolor="#e0e0e0" style="width:153px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Clinical Status</span></p>
</td>
<td valign="middle" width="153" bgcolor="#e0e0e0" style="width:153px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Custom Fields</span></p>
</td>
<td valign="middle" width="141" bgcolor="#e0e0e0" style="width:141px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Employee</span></p>
</td>
<td valign="middle" width="125" bgcolor="#e0e0e0" style="width:125px; height:23px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Facility Information</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" bgcolor="#ccffff" style="width:105px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">DB View Name:</span></p>
</td>
<td valign="middle" width="127" bgcolor="#ccffff" style="width:127px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt_PatientCareEnded</span></p>
</td>
<td valign="middle" width="153" bgcolor="#ccffff" style="width:153px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientClinicalStatus</span></p>
</td>
<td valign="middle" width="153" bgcolor="#ccffff" style="width:153px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _CustomField_Results</span></p>
</td>
<td valign="middle" width="141" bgcolor="#ccffff" style="width:141px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _Employee</span></p>
</td>
<td valign="middle" width="125" bgcolor="#ccffff" style="width:125px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _Facility</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Data Fields:</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">ART Ended</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Clinical Signature</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Custom Field Label</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Employee Designation</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">App Grace Period</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">ART Ended Date</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Date HIV Diagnosis</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Custom Field Result</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Employee First Name</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Country Num</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">ART Ended Reason</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Disclosure</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Employee Last Name</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Currency</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Care Ended</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Disclosure Relationship</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;"> (All of the custom fields created </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Employee Name</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Facility Name</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Care Ended Date</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Diagnosis Verified</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;"> by the site will be in the field </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">LPTF Num</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Care Ended Signature</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">LMP</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;"> select list)</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">PEPFAR Start Date</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Death Date</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Pregnant</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Satellite Num</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Death Reason</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Death Reason Description</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">LPTF Transferred To</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Stopped Reason</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Stopped Reason Other</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Exit Reason</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="105" style="width:105px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="127" style="width:127px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="153" style="width:153px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="141" style="width:141px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="125" style="width:125px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
</table>
</div>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
<div style="text-align: center; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 0px;"><table align="center" width="868" cellspacing="0" cellpadding="4" border="0" style="border: none; border-spacing:0px; border-collapse: collapse;">
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="86" bgcolor="#e0e0e0" style="width:86px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Field Groups:</span></p>
</td>
<td colspan="2" valign="middle" width="111" bgcolor="#e0e0e0" style="width:111px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Family Information</span></p>
</td>
<td colspan="2" valign="middle" width="138" bgcolor="#e0e0e0" style="width:138px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">HIV Information</span></p>
</td>
<td colspan="2" valign="middle" width="166" bgcolor="#e0e0e0" style="width:166px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">HIV Previous Care</span></p>
</td>
<td colspan="2" valign="middle" width="140" bgcolor="#e0e0e0" style="width:140px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Laboratory</span></p>
</td>
<td colspan="2" valign="middle" width="143" bgcolor="#e0e0e0" style="width:143px; height:32px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">OIs or AIDS Defining Illnesses</span></p>
</td>
<td valign="top" style="border: solid 1px #000000;"><br>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" bgcolor="#ccffff" style="width:87px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">DB View Name:</span></p>
</td>
<td colspan="2" valign="middle" width="111" bgcolor="#ccffff" style="width:111px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt_Family Information</span></p>
</td>
<td colspan="2" valign="middle" width="138" bgcolor="#ccffff" style="width:138px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientHIVOther</span></p>
</td>
<td colspan="2" valign="middle" width="166" bgcolor="#ccffff" style="width:166px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientHIVPreviousCare</span></p>
</td>
<td colspan="2" valign="middle" width="140" bgcolor="#ccffff" style="width:140px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _Laboratory</span></p>
</td>
<td colspan="2" valign="middle" width="143" bgcolor="#ccffff" style="width:143px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _OISorAIDSDefingIllnesses</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Data Fields:</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Family Member Name</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Enrollment Support Group</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Ever Been on ART</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">AIDSRelief Financed Lab</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Date Of Disease</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Care Status</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Barrier</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ART Sponsor</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Checked by Date</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Defining Illness</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Status</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Disclosure</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ART Sponsor Other</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Checked by Name</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Defining Illness Description</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Registered</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Disclosure Other</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous Care Type</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lab Department</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Relationship</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">HIV Status</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous Care Type Other</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lab Ordered by</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Relationship date</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num Household HIV Died</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous HIV Care</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lab Ordered by Date</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Relative Age (Month)</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num Household HIV Positive</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous Medical Records</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lab Test</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Relative Age (Year)</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num Household HIV Tested</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lab Unit</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Relative Sex</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Referred From Inpatient Ward</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Max Boundary Value</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Referred From </span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Min Boundary Value</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Support Group Name</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Pre Clinic Lab Date</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Reported by </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Reported by Date</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Test Results (text or numeric)</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" valign="middle" width="87" style="width:87px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="111" style="width:111px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="138" style="width:138px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1" style="margin: 0px 0px 0px 3px;"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="140" style="width:140px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td colspan="2" valign="middle" width="143" style="width:143px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
</table>
</div>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<div style="text-align: center; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 0px;"><table align="center" width="888" cellspacing="0" cellpadding="4" border="0" style="border: none; border-spacing:0px; border-collapse: collapse;">
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" bgcolor="#e0e0e0" style="width:106px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Field Groups:</span></p>
</td>
<td valign="middle" width="178" bgcolor="#e0e0e0" style="width:178px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Adherence</span></p>
</td>
<td valign="middle" width="178" bgcolor="#e0e0e0" style="width:178px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Appointment</span></p>
</td>
<td valign="middle" width="178" bgcolor="#e0e0e0" style="width:178px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Assessment and Therapy</span></p>
</td>
<td valign="middle" width="178" bgcolor="#e0e0e0" style="width:178px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Contacts</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" bgcolor="#ccffff" style="width:106px; height:29px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">DB View Name:</span></p>
</td>
<td valign="middle" width="178" bgcolor="#ccffff" style="width:178px; height:29px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientAdherence</span></p>
</td>
<td valign="middle" width="178" bgcolor="#ccffff" style="width:178px; height:29px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientAppointment</span></p>
</td>
<td valign="middle" width="178" bgcolor="#ccffff" style="width:178px; height:29px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientAssessment</span></p>
<p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientTherapy</span></p>
</td>
<td valign="middle" width="178" bgcolor="#ccffff" style="width:178px; height:29px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientContacts</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Data Fields</span><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">:</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Adherence Code</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Appointment Date</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">AIDSRelief ARV Start Date</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Address</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Adherence Other Details</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Appointment Provider</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Assessment Category</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Discuss Status</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Adherence Support Group</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Appointment Purpose</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Assessment Description - IE</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Knows HIV Status</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Herbal Meds</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Appointment Status</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Assessment Name</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Name</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Interrupted Date</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Therapy Plan</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Phone</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Interrupted Num Days</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Therapy Reason Code</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Emergency Contact Relationship</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Missed Last Week</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Missed Last Month</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num DOT Per Week</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num Home Visits Per Week</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Stopped Date</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Stopped Num Days</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="top" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="178" style="width:178px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
</table>
</div>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<div style="text-align: center; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 0px;"><table align="center" width="939" cellspacing="0" cellpadding="4" border="0" style="border: none; border-spacing:0px; border-collapse: collapse;">
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" bgcolor="#e0e0e0" style="width:103px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Field Groups:</span></p>
</td>
<td valign="middle" width="191" bgcolor="#e0e0e0" style="width:191px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Demographics</span></p>
</td>
<td valign="middle" width="191" bgcolor="#e0e0e0" style="width:191px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Patient Symptoms</span></p>
</td>
<td valign="middle" width="202" bgcolor="#e0e0e0" style="width:202px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Pharmacy</span></p>
</td>
<td valign="middle" width="181" bgcolor="#e0e0e0" style="width:181px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Previous Regimen</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" bgcolor="#ccffff" style="width:103px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">DB View Name:</span></p>
</td>
<td valign="middle" width="191" bgcolor="#ccffff" style="width:191px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientDemographics</span></p>
</td>
<td valign="bottom" width="191" bgcolor="#ccffff" style="width:191px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientSymptoms</span></p>
</td>
<td valign="bottom" width="202" bgcolor="#ccffff" style="width:202px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PharmacyDispense</span></p>
</td>
<td valign="bottom" width="181" bgcolor="#ccffff" style="width:181px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientHivPrevCareIE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Data Fields</span><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">:</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Age</span></p>
</td>
<td valign="bottom" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Symptom Category</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">AIDSRelief Financed Drug</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Allergy Name</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Age at Enrollment</span></p>
</td>
<td valign="bottom" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Symptom Description</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Dispensed By</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Allergy Other Details</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">AIDSRelief ART Start Date</span></p>
</td>
<td valign="bottom" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Symptom Name</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Dispensed By Date</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">CD4 % Prior to ARVs</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Current ART Regimen</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Dispensed Quantity</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">CD4 Prior to ARVs</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Current ART Regimen Start Date</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Dose</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">CD4 Prior to ARVs Date</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Date of Birth</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Drug Abbreviation</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Current ART - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Distance Travelled (Km)</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Drug Name</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Current ART Start Date - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">District</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Drug Type</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Other - 1</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Education Level</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Duration</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Other Desc - 1</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Employment Status</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Frequency</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Other Desc - 2</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Enrollment Date</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Generic Drug Name</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Other Desc - 3</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Existing Hosp/Clinic #</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Hold Medicine</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Sulfa</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Literacy</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Order Type {text translation}</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term Meds Sulfa Desc</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Local Council</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Ordered Quantity</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term TB Med Desc</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Marital Status</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Pharmacy Ordered By</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term TB Medication</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Monthly Income</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Pharmacy Ordered By Date</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Long Term TB Start Date</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num Children</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Regimen</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lowest CD4 - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Num People In Household</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Treatment Program</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lowest CD4 Date - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Occupation</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">ARV Provider</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Lowest CD4 Percent - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Address</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Regimen Code</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Most Recent CD4 - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Enrollment #</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">OI Treatment</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Most Recent CD4 Date - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient First Name</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Most Recent CD4 Percent - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Last Name</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Most Recent Viral Load Date - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Location</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Most Recent Viral Load - IE</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Name</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Phone</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen Months</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Patient Status</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen1 Current</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Province</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen1 Months</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Sex</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen1 Name</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Status Changed Date</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Time Travelled</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Travel Units</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Village</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="103" style="width:103px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="191" style="width:191px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="202" style="width:202px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="181" style="width:181px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
</table>
</div>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 0px;"><table width="878" cellspacing="0" cellpadding="4" border="0" style="border: none; border-spacing:0px; border-collapse: collapse;">
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="107" bgcolor="#e0e0e0" style="width:107px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Field Groups:</span></p>
</td>
<td valign="middle" width="166" bgcolor="#e0e0e0" style="width:166px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Previous Regimen (continued)</span></p>
</td>
<td valign="middle" width="166" bgcolor="#e0e0e0" style="width:166px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Therapy and Adherence</span></p>
</td>
<td valign="middle" width="106" bgcolor="#e0e0e0" style="width:106px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Visit</span></p>
</td>
<td valign="middle" width="142" bgcolor="#e0e0e0" style="width:142px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Vital Signs</span></p>
</td>
<td valign="bottom" width="107" bgcolor="#e0e0e0" style="width:107px; height:17px; background-color:#e0e0e0; border: solid 1px #000000;"><p class="p_Normal-1" style="text-align: center;"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">WAB &amp; WHO Stage</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="107" bgcolor="#ccffff" style="width:107px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">DB View Name:</span></p>
</td>
<td valign="middle" width="166" bgcolor="#ccffff" style="width:166px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientHivPrevCareIE</span></p>
</td>
<td valign="middle" width="166" bgcolor="#ccffff" style="width:166px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _AdherenceMissedReason</span></p>
</td>
<td valign="middle" width="106" bgcolor="#ccffff" style="width:106px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _Visit</span></p>
</td>
<td valign="bottom" width="142" bgcolor="#ccffff" style="width:142px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientVitals</span></p>
</td>
<td valign="bottom" width="107" bgcolor="#ccffff" style="width:107px; height:17px; background-color:#ccffff; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-style: italic;">Rpt _PatientStage</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="middle" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial'; font-weight: bold;">Data Fields</span><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">:</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen2 Current</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Reason Category</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Treatment Location</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">BP Diastolic</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">WAB Stage</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen2 Months</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Reason Code</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Visit Type</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">BP Systolic</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">WHO Stage</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen2 Name</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Visit Date</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Heart Rate</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen3 Current</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Height (cm)</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen3 Months</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Pain</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen3 Name</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Respiratory Rate</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen4 Current</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Temp (°C)</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen4 Months</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Weight (kg)</span></p>
</td>
<td valign="bottom" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Previous ARV Regimen4 Name</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';"> </span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Single Dose NVP</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="bottom" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1" style="font-size: 8pt; font-family: 'Arial';">Single Dose NVP Date-1</span></p>
</td>
<td valign="middle" width="166" style="width:166px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="106" style="width:106px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="142" style="width:142px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
<td valign="middle" width="107" style="width:107px; height:17px; border: solid 1px #000000;"><p class="p_Normal-1"><span class="f_Normal-1">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
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